Provider Demographics
NPI:1134193337
Name:DODDS, TERRY CLANTON (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:CLANTON
Last Name:DODDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:4355 HICKORY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-2014
Practice Address - Country:US
Practice Address - Phone:828-757-5040
Practice Address - Fax:828-757-5041
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31128208000000X
FLME39446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28792OtherBCBS
NC7928792Medicaid
FL271237700Medicaid
FL271237700Medicaid